Many women (up to 90%) have menstrual cramps. Most are simply due to menstruation itself and
don't indicate any underlying gynecological problems. The medical term for this is
Primary Dysmenorrhea. Dysmenorrhea is from Latin words meaning "bad menstruation" (no joke!).

PRIMARY DYSMENORRHEA (MENSTRUAL CRAMPS) CHARACTERISTICS Menstrual cramps start a day or so before actual menses. They are felt in the lower or middle
abdomen. They can radiate (spread) to the hips, thighs, and back. They are decribed as a
"colicky" type of pain. That means the pain rises to a peak
and falls, and starts over again. This reflects the contractions of the uterus that underlie the
cramps.

The severity of cramps varies widely from woman to woman and even between the same woman's
periods. Some have cramps that are barely noticable. Some have crampes that are
excruitating. They may also have weakness, chills, and dizziness. Gasto-intestinal symptoms are also
common with severe cramps: nausea, vomitting, and diarrhea. Spasms of the leg and abdominal
muscles occurs with severe cramps.

PRIMARY (NORMAL) VS. SECONDARY (UNDERLYING PROBLEMS): WHO GETS WHICH Secondary dysmenorrhea is when cramps are due to an actual disease, such as endometriosis.
The severity is NOT a clue as to whether or not the cramps are due to a disease that needs to
be treated.

Primary dysmenorrhea is more likely in women whose first period was early in life and those
who have heavier flow. It is common in the first year or so of a girl's menstruation, no
matter when she starts. Secondary is more likely when the problem starts after the age of
25, or when there are other symptoms. Still, the only way to know is to be looked at by
a doctor.

THE GOOD NEWS Menstrual cramps are closely tied to ovulatory cycles. So, that means women who have them are
showing an important sign of their potential for fertility.

MECHANISM: HOW MENSTRUAL CRAMPS HAPPEN A substance called prostagladins are the cause of most symptoms with
dysmenorrhea. These are produced by the body and found in the uterine lining.
When the lining starts to shed with menstruation, they are released.
They cause the uterus to contract forcefully, which
is the reason for much of the cramping itself.

They also cause
vasodilation of the circulatory system. In other words, the arteries
and veins expand, so they pool blood instead of circulating it. This can cause
pelvic congestion (blood pooling in the pelvis) and this itself causes discomfort and heaviness.
It can drops the woman's blood pressure and therefore, the reason she might feel
cold, clammy and lightheaded (the blood is diverted).
In some women, it also causes
contraction and spasm of the smooth muscle of the
gastro-intestinal tract. This leads to nausea, vomiting and diarrhea.

The flow itself is part of the problem. Heavy flow or clots in the menstruation have to squeeze out
through the small opening of the cervix. This stretching is believed to cause pain as well. This
is believed to be the the reason some women's cramps subside or disappear after their first baby. The cervical
opening has widened.

SELF TREATMENT FOR MENSTRUAL CRAMPS
Medications
The main treatment for menstrual cramps are a class of drugs called Non-steroidal
anti-inflammatory drugs or NSAIDs for short. These are drugs every woman
knows: ibuprofen (Motrin) or Naproxen (Aleve). They work by stopping the body
from making prostagladins. They also work by preventing blood clotting.

They are not aspirin-related. So allergies or reactions to aspirin
don't matter. They are safe for girls too. In spite of their pain-relieving properties, they
are not narcotic. So, there is absolutely no reason to avoid them for women who don't want to
be drowsy or have their thinking ability affected. They are not addicting either.

NSAIDs should be avoided if there
are any kind of bleeding problems including stomach ulcers. They
are a bit irritating to any woman's stomach, and should be taken with food.
NSAIDs should be avoided if a woman suspects pregnancy.

How to Take Them
Prostagladins are produced but quickly degraded in the body, in about a half hour. So, if a woman
gets the NSAIDS on board before the cramps get going, she can short-circuit the whole process.
If a woman is regular (if she knows approximately when, not the exact day), she can take the
pill of her choice a few days before she starts. She can also gauge the start based on PMS
symptoms or the first twinges of cramps. After the start is OK too.

There are scores of different medications and brands to choose from. Different formulations
work well on different women. This is becauese prostagladin production is a whole series of
events. Different drugs in the NSAID category work on different stages of this process. There
are individual differences as to which level of intervention works best. There is no way to
predict which drug will work best on a particular woman.

She should simply try one and then
a different one, if it doesn't work. Check the back of the bottle for the generic chemical
name to make sure the medication is not another brand name for the same drug. She should ask the
pharmacist for help to find an NSAID that is subtantially different than the last one
she tried.

Generic ibuprofen is a good place to start, as it is the cheapest. Enteric coated are a better
starting place for those with weak stomaches. Long-acting or once-a-days may be the first
choice for teens whose schools restrict bringing pills to schoo or women who get infrequent breaks during the day. Also, remember to take one of the ones that lasts at least 12 hours when using them overnight. This is important as cramps are more likely when the period starts overnight and the blood pools and clots while lying down.

Other Self-Treaments
Exercise in general has also been shown to help alleviate
dysmennorhea. It is not known to help the severe cramping (like those women
could get up a jog anyway). A number of herbal, natural, and alternative medicine treatments
claim to help. None has substantial scientific evidence, yet.

WHEN SELF TREATMENT IS NOT ENOUGH
If none of the over-the-counter types work, there are also a number of prescription NSAIDs
available. The longer acting ones tend to be prescription only. This means the woman will
need to visit the doctor. This can be a good time to make sure the cramps are primary and not
secondary.

If prescription NSAIDs don't work, birth control pills can lessen the
menstrual flow and solve the problems of dysmenorrhea for many
women. In resistent cases narcotic pain relievers can also be
used.